| NPI | 1013376433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F312180) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 677489) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F312180) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F312180) | |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2025-12-02 |