| NPI | 1952308264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN109891 AP1969) |
| Additional Taxonomies | 364SN0800X Clinical Nurse Specialist, Neuroscience (Licence: AZ RN109891 AP1969) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2008-01-29 |