| NPI | 1821746504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: WA AP61521783) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-178641) |
| Enumeration Date | 2022-03-12 |
| Last Update Date | 2024-01-27 |