| NPI | 1053545582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APN001107) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN1107) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2024-07-11 |