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 |