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 |