| NPI | 1417469941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9239489) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9239489) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2021-10-01 |