| NPI | 1407440548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL APRN11011730) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11011730) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2023-01-11 |