| NPI | 1851537211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5001546) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA 5001546) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2024-07-31 |