| NPI | 1275211898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 14242940-4405) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: IL 209027805) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2025-11-12 |