| NPI | 1952997074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310105) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY RN-582808-1) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 310105) | |
| Enumeration Date | 2020-12-13 |
| Last Update Date | 2021-11-04 |