NPI | 1093332702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 1061391) |
Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: LA 200458) |
Enumeration Date | 2020-06-29 |
Last Update Date | 2022-01-31 |