| NPI | 1346010204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11031869) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11031869) |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-05-06 |