| NPI | 1790443521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 310467) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NY 310467) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: NY 310467) | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2022-02-11 |