| NPI | 1568912608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA AP09059) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: LA RN130518) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2026-06-16 |