| NPI | 1356825632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9490053) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9490053) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9490053) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9490053) | |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2022-02-22 |