| NPI | 1366949018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9309659) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9309659) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9309659) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2023-09-20 |