| NPI | 1891758421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX 625650) |
| Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX 625650) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2016-11-17 |