| NPI | 1548680408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL ARNP9203764) |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist Gerontology (Licence: FL ARNP9203764) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2014-04-18 |