| NPI | 1447666086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN3361362) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN3361362) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2025-07-24 |