| NPI | 1720631542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11004945) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: FL RN9480510) |
| Enumeration Date | 2019-07-21 |
| Last Update Date | 2022-09-26 |