| NPI | 1598264426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F308684) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F308684) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP136467) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2019-12-09 |