| NPI | 1710456157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5019062) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9361615) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9361615) | |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2024-02-02 |