| NPI | 1770144453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP030492) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: CO 1624208) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2024-09-10 |