| NPI | 1245795996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN11000965) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: FL 11000965) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2019-10-16 |