| NPI | 1326153198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 582080) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: TX 582080) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 582080) | |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX 582080) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-11-28 |