| NPI | 1346527421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 30 305708) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 34 340808) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2015-07-06 |