NPI | 1093295099 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9182796) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9182796) |
Enumeration Date | 2018-08-19 |
Last Update Date | 2025-08-15 |