| NPI | 1790728954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9190058) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: FL ARNP9190058) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9190058) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-02-10 |