| NPI | 1316427313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9335595) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: FL aprn9335595) |
| Enumeration Date | 2018-08-19 |
| Last Update Date | 2023-02-21 |