| NPI | 1851830558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9297316) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL ARNP9297316) |
| 363L00000X Nurse Practitioner (Licence: FL APRN9297316) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9297316) | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2026-04-30 |