| NPI | 1942874714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 310333) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 310333) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-07-07 |