| NPI | 1588295141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309404) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 309404) |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2020-05-14 |