| NPI | 1235838012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11024985) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11024985) |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2024-04-12 |