| NPI | 1902259310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9377668) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9377668) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9377668) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2019-06-20 |