| NPI | 1518541002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN281353) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA RN281353) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-01-05 |