| NPI | 1245724723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: GA RN235639) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: GA RN235639) |
| 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: GA RN235639) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2018-11-13 |