| NPI | 1902187602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN 926) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN R1806931) |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: MN R1806931) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2024-09-17 |