| NPI | 1356011308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: CA 95018479) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95094471) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: CA 95018479) | |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-02-11 |