| NPI | 1124362488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001442) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APN001442) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2021-03-01 |