| NPI | 1790140937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: ID 2161178) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 2161178) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9415036) | |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2025-08-08 |