| NPI | 1851058796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TN 104138162) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 12191572) |
| Enumeration Date | 2021-11-28 |
| Last Update Date | 2023-10-26 |