NPI | 1386473684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11033726) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11033726) |
363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11033726) | |
Enumeration Date | 2024-07-26 |
Last Update Date | 2025-04-01 |