| NPI | 1306184510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306156) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 340868) | |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2013-01-22 |