| NPI | 1780387555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11025386) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11025386) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-12-21 |