| NPI | 1710098470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F333285-1) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 333285) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-07-05 |