| NPI | 1538243696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 960052) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 960052) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-11-20 |