| NPI | 1790139129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306837-1) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340952-1) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |