| NPI | 1417319187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 309252) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 309252) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-07-07 |