| NPI | 1134573942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 834290) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 834290) |
| 101Y00000X Counselor | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-06-26 |