| NPI | 1013458561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9336037) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 64577) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 73900) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71013924A) | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2024-08-26 |