| NPI | 1174003065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0090174) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: OK R0090174) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2018-09-24 |