| NPI | 1982084257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 382538) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: NY 382538) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-06-28 |