| NPI | 1992563316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11029081) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 11029081) |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: FL 11029081) | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-03-11 |