| NPI | 1922342161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: NH 088805-23) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: TN 17219) |
| Enumeration Date | 2012-11-10 |
| Last Update Date | 2022-09-21 |