| NPI | 1659185460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11037955) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9383499) |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2025-03-06 |