| NPI | 1154705051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9325102) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9325102) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP 9325102) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9325102) | |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2023-10-11 |