| NPI | 1134973753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TN 40131) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: SC 243287) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2025-11-04 |