| NPI | 1114587482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9423301-4409) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: UT 9423301-3102) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-10-30 |