| NPI | 1033506498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APRN001948) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95002022) |
| 163W00000X Registered Nurse (Licence: NV RN82977) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2016-11-08 |