| NPI | 1124651344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11010305) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11010305) |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2021-12-01 |