| NPI | 1255658282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5004719) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004719) |
| 207T00000X Neurological Surgery (Licence: NC 5004719) | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2026-04-19 |