| NPI | 1437451168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MT 103781) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: MT 26691) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2016-06-23 |