| NPI | 1336229251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: MN R-146513-6) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN r1465136) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-07-22 |