| NPI | 1235751967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NY 350502) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 755499) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-10-29 |