| NPI | 1669955696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX AP138788) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP138788) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2024-06-26 |