| NPI | 1053506899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-129274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD T20071316) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11001771) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AL 1-129274) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2020-03-11 |