| NPI | 1710715263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5020523) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: SC 262487) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: NC 0000000) | |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: SC 30820) | |
| Enumeration Date | 2024-07-25 |
| Last Update Date | 2026-08-18 |