| 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 |