| NPI | 1972020527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9239689) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9239689) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2024-03-15 |