| NPI | 1124366224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306047-1) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340844-1) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2013-01-23 |