| NPI | 1891376893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 310585) |
| Additional Taxonomies | 163WG0600X Registered Nurse Gerontology (Licence: NY 667923) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2022-04-07 |