| NPI | 1174173066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: MO 2016014841) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: MO 0) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2020-08-10 |