| NPI | 1831187012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP1921112) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL R78479) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2008-08-01 |