| NPI | 1912649286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: WA AP61323713) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61099812) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-06-28 |