| NPI | 1235464710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NM CNP00214) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: NM CNP00214) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2016-04-05 |