| NPI | 1235219874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner Neonatal (Licence: KS 45860) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner Neonatal, Critical Care (Licence: MO 2006016795) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-06-29 |