| NPI | 1083325567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11023331) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11023331) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11023331) | |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2023-03-07 |