| NPI | 1669540019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: FL 1702192) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL ARNP 1702192) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2012-04-04 |