| NPI | 1811509961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11008730) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11008730) |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: FL APRN11008730) | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2022-02-12 |