| NPI | 1659643054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA AP06807) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA TAP002754) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2020-10-08 |