| 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 |