| NPI | 1528572088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: WA AP60811289) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: WA RN60769449) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |