| NPI | 1699124552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: VA 0024181021) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: CO C-APN.0100402) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2026-05-26 |