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 |