| NPI | 1457819385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11009421) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9477989) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2022-02-07 |