| NPI | 1164060547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11006155) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9421121) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2020-04-07 |