| NPI | 1265997308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11002729) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN3389152) |
| 163WN0800X Registered Nurse, Neuroscience (Licence: FL RN3389152) | |
| Enumeration Date | 2019-02-03 |
| Last Update Date | 2022-07-05 |