| NPI | 1437700093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11004260) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL RN9483054) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-05-05 |