| NPI | 1053044081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11016116) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11016116) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11016116) | |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: FL 11016116) | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2024-07-11 |