| NPI | 1265920607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11014944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 722087) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11014944) | |
| 363L00000X Nurse Practitioner (Licence: NV 811582) | |
| 363L00000X Nurse Practitioner (Licence: CA 95008875) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11014944) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2023-01-25 |