| NPI | 1528554003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9451580) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9451580) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9451580) | |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2021-07-16 |