Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207T00000X | Neurological Surgery | | | | Yes |
| 2 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 3 | 2084N0402X | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | | | No |
| 4 | 2084V0102X | Psychiatry & Neurology | Vascular Neurology | | | No |
| 5 | 225100000X | Physical Therapist | | | | No |
| 6 | 2251N0400X | Physical Therapist | Neurology | | | No |
| 7 | 363A00000X | Physician Assistant | | | | No |
| 8 | 363LA2100X | Nurse Practitioner | Acute Care | | | No |
| 9 | 363LF0000X | Nurse Practitioner | Family | | | No |