| NPI | 1225054075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: AZ 54349) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: AZ AP6382) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-05-10 |