| NPI | 1477700722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9316143) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9316143) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 02-128) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2015-04-24 |