| NPI | 1295521185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: KY 4042941) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: KY 1147459) |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2025-07-31 |