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 |