| NPI | 1659857662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN239990) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA RN239990) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2025-04-22 |