| NPI | 1518466473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11010209) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308550) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00732300) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2020-12-08 |