| NPI | 1154691236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: IN 71003698) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: IN 28196318) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2021-02-17 |