| NPI | 1609634179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX 1154692) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 1154692) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-04-09 |