| NPI | 1770087322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: FL APRN9338531) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9338531) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN9338531) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2021-04-29 |