| NPI | 1447708979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: IN 71007790A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28194228A) |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: OH RN.429014) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2022-03-28 |