| NPI | 1174288849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11016917) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 29949) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 29949) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TN 29949) | |
| Enumeration Date | 2021-11-07 |
| Last Update Date | 2022-01-26 |