| NPI | 1457748345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9288390) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9288390) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL ARNP9288390) | |
| Enumeration Date | 2015-04-19 |
| Last Update Date | 2022-07-14 |