| NPI | 1669162137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: ID 53654) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: ID 53654) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: ID 104775275) | |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2024-01-24 |