| NPI | 1639539539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F308078) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 704370) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2022-07-21 |