| NPI | 1780101147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL AG0816106) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9162820) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL AG0816106) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL AG0816106) | |
| Enumeration Date | 2017-08-27 |
| Last Update Date | 2022-07-21 |