| NPI | 1518898188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MO 2026040577) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: MO 2020003121) |
| Enumeration Date | 2026-05-25 |
| Last Update Date | 2026-08-26 |