| NPI | 1194389569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV 820033) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: NV 820033) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-07-13 |