| NPI | 1366723439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN11013151) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: FL 10266) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: FL AG03210115) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2023-01-04 |