NPI | 1902862618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: MN R0804798) |
Additional Taxonomies | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: MN R0804798) |
Enumeration Date | 2006-04-21 |
Last Update Date | 2007-07-08 |