| NPI | 1144308743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: CA NP16648) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OK 224455) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2026-07-08 |