| NPI | 1750832200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9407361) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9407361) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2020-04-07 |