| NPI | 1083020325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NY f306015-1) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY f340840-01) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2014-07-08 |