| NPI | 1891940839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NC 930163) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 930163) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2023-08-30 |