| NPI | 1356375034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX AP109000) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 624928) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 624928) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2015-04-15 |