| NPI | 1528480431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: FL APRN9265106) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: FL ARNP9265106) |
| Enumeration Date | 2014-01-11 |
| Last Update Date | 2025-02-28 |