| NPI | 1366002610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MO 2019034747) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11041298) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MO AG06190034) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-11-10 |