| NPI | 1487011557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9333526) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: FL ARNP9333526) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2018-10-02 |