| NPI | 1730833542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP034570) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: AK NURR35829) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: AK 189895) | |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2025-12-09 |