| NPI | 1760262448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WS0121X Registered Nurse, Plastic Surgery (Licence: NY 850445) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 312846) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2026-06-03 |