| NPI | 1639975907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 582379) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ AG02250044) |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-10-28 |