| NPI | 1093485427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN11015956) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11015956) |
| 163W00000X Registered Nurse (Licence: FL RN9339925) | |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2021-11-02 |