| NPI | 1225251259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: CO 180648) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN051767) |
| 363L00000X Nurse Practitioner (Licence: LA AP02090) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2022-10-05 |