| NPI | 1336950021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: NC 5021792) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: NC 350338) |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-07-28 |