| 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 |