| NPI | 1962908806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TX AP137284) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: TX 754871) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2021-06-23 |