| NPI | 1568892552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9314833) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9314833) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9314833) | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2020-04-17 |