| NPI | 1427508332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9306563) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9306563) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2022-09-26 |