| NPI | 1407423098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MO 2021023271) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-80254-112) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: KS 53-80254-112) | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2024-06-12 |