| NPI | 1124541842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN9412873) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: FL RN9412873) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2020-11-04 |