| NPI | 1225223001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX HAG1-0433-4054) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 752517) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 752517) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2011-04-05 |