| NPI | 1295007714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN11017836) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 617481) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11017836) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NY 307565) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2022-10-20 |