| NPI | 1023363397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306105) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: NY 340849) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2020-06-26 |