| NPI | 1184162349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MO 2018023176) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN CNP5066) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2021-03-02 |