| NPI | 1427516087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NY 308636) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NY 308636) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NY F308636-1) | |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2023-11-16 |