| NPI | 1154656494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: LA AP05923) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP118216) |
| 363L00000X Nurse Practitioner (Licence: LA AP05923) | |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 774685) | |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: LA AP05923) | |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX 774685) | |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2023-05-11 |