| NPI | 1417423708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: ID 61248) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 739902) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2024-03-19 |