| NPI | 1124739735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 886175) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 332386) |
| 163WE0003X Registered Nurse, Emergency (Licence: NV Rn91768) | |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2026-10-08 |