| NPI | 1023668829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11004705) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11004705) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2020-04-09 |