| NPI | 1689348567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: WI 11157-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 253009-30) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2022-02-21 |