| NPI | 1154797470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ARNP9259531) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL ARNP9259351) |
| 146D00000X Personal Emergency Response Attendant (Licence: FL ARNP9259351) | |
| 174400000X Specialist | |
| 251G00000X Hospice Care, Community Based (Licence: FL ARNP9259351) | |
| 281P00000X Chronic Disease Hospital (Licence: FL ARNP9259351) | |
| 282E00000X Long Term Care Hospital (Licence: FL ARNP9259351) | |
| 302R00000X Health Maintenance Organization (Licence: FL ARNP9259351) | |
| 305R00000X Preferred Provider Organization (Licence: FL ARNP9259351) | |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 9259351) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9259351) | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2023-06-02 |