| NPI | 1760782312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704244629) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: IN 28192225) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: IN 71003429A) | |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2012-10-04 |