| NPI | 1467897801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: GA RN273892) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: AL 1-122673) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2018-02-19 |