| NPI | 1891212973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9375106) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ARNP9375106) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-07-21 |