| NPI | 1689318685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 310084) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: NY F310084-01) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2022-12-09 |