| NPI | 1558877860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F308319-1) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F308319) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2024-04-04 |