| NPI | 1548598899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5004575) |
| Additional Taxonomies | 163WN0800X Registered Nurse Neuroscience (Licence: NC 220326) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2024-02-15 |