| NPI | 1619434164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 1060421) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: NM 54906) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2022-05-09 |