| NPI | 1184131583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11001664) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9465327) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2022-03-07 |