| NPI | 1669787826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: OR 10021991) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OR 10021991) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2024-08-21 |