| NPI | 1487767117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: IL 209014169) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: NY 350263) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: FL 942926-6) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2016-04-08 |