| NPI | 1588229215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY f3439281) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY f3439281) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2021-02-11 |