| NPI | 1841849643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71011124A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11003325) |
| 363L00000X Nurse Practitioner (Licence: PA RN689782) | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2021-08-05 |