| NPI | 1053790782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 826829) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-1830) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-09-11 |