| NPI | 1356594360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: NC 141392) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NC 141392) |
| 363L00000X Nurse Practitioner (Licence: NC 141392) | |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2021-06-08 |