| NPI | 1619133253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP3237) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2910702) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP2910702) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2014-07-23 |