| NPI | 1417968215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 304617) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304155) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2019-04-17 |