| NPI | 1770992836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F310989-01) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 007794) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F310989-01) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F310989-01) | |
| Enumeration Date | 2014-08-03 |
| Last Update Date | 2025-06-04 |