| NPI | 1215799556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311655) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ14990800) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-05-14 |