| NPI | 1215417068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: FL APRN2519972) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL APRN2519972) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN2519972) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2022-01-24 |