| NPI | 1578101226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11007830) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: FL RN9374509) |
| 163WR0400X Registered Nurse, Rehabilitation (Licence: FL RN9374509) | |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2022-01-18 |