| NPI | 1780335299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: FL APRN11021148) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11021148) |
| 163W00000X Registered Nurse (Licence: FL RN9351561) | |
| Enumeration Date | 2022-01-16 |
| Last Update Date | 2024-06-03 |