| NPI | 1457371767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: CA G37522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G37522) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-02-06 |