| NPI | 1174932743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9232011) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9232011) |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2024-07-01 |