| NPI | 1265942791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9382978) |
| Additional Taxonomies | 364SX0200X Clinical Nurse Specialist, Oncology (Licence: FL APRN9382978) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2021-03-31 |