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 |