| NPI | 1124167440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APRN000923) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NV APN000923) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2021-07-06 |