| NPI | 1922779636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11015373) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2373500) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11015373) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2022-12-28 |