| NPI | 1750142097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 35173) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TN 35173) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-02-21 |