| NPI | 1740764257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11000190) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11000190) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2021-05-13 |