| NPI | 1962738385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: GA RN184383) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA Rn184383) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2013-09-19 |