| NPI | 1962848770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 336749) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 336749) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2023-07-07 |