NPI | 1669787826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: OR 10021991) |
Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: WA RN61524321) |
363LN0000X Nurse Practitioner, Neonatal (Licence: WA AP61524323) | |
Enumeration Date | 2010-08-12 |
Last Update Date | 2025-08-21 |