| NPI | 1457760175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9314537) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN9314537) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9314537) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9314537) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9314537) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-10-05 |