| NPI | 1306436944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN11013757) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: FL APRN11013757) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2024-09-24 |