| NPI | 1730625757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9267931) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 312684) |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2026-02-05 |