| NPI | 1366951998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 431186) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 431186) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2023-06-29 |