| NPI | 1912633611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: NY 000000) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 432484) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2023-07-22 |