| NPI | 1902417553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024179857) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: VA 0024179857) |
| Enumeration Date | 2020-08-16 |
| Last Update Date | 2023-09-11 |