| NPI | 1043219587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F304782) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R055430) |
| 163W00000X Registered Nurse (Licence: NY 541137) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340615) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2016-04-29 |