| 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 |