| NPI | 1467952861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9428686) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9428686) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2021-03-30 |