| NPI | 1851758627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11027934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 864562) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11027934) | |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2024-02-19 |