| NPI | 1750805966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: FL APRN11000874) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: KY 3011594) |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2026-01-14 |