| NPI | 1669873220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ AP7300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7300) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2019-06-27 |