NPI | 1053895078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9348711) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9348711) |
Enumeration Date | 2018-09-17 |
Last Update Date | 2023-09-07 |