| NPI | 1861414880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA AP04111) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN088484) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2017-09-25 |