| NPI | 1922565951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309014) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 309014) |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2019-02-27 |