| NPI | 1689049041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9281306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9281306) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2026-03-11 |