| NPI | 1700460573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11012975) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11012975) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11012975) | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2021-05-07 |