| NPI | 1538891080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MT NUR-APRN-LIC-195857) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: MT NUR-APRN-LIC-195857) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2023-02-07 |