| NPI | 1619556198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA 201953) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: LA 201953) |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: LA 201953) | |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2022-12-15 |