| NPI | 1326745290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 1174138) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 846214) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2024-09-13 |