| NPI | 1265504245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340894) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 3067471) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F4000931) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-03-07 |