| NPI | 1720460124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9325152) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9325152) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2021-04-01 |