| NPI | 1851778062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11000196) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP11000196) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2023-06-14 |