| NPI | 1316299456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: IL 209009916) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: IL 209009916) |
| Enumeration Date | 2012-10-14 |
| Last Update Date | 2021-07-19 |