| NPI | 1598964629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: NC 5015451) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA 02915) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: LA AP02915) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2022-06-02 |