| NPI | 1952775199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9311770) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9311770) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9311770) | |
| Enumeration Date | 2015-11-28 |
| Last Update Date | 2015-12-02 |