| NPI | 1083601017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024164923) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: VA 0001133791) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2012-04-03 |