| NPI | 1235478843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005939) |
| Additional Taxonomies | 364SN0800X Clinical Nurse Specialist, Neuroscience (Licence: VA 0110005939) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2025-12-18 |