| NPI | 1366207375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN 11879) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: MN 2434551) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-07-30 |