| NPI | 1144750068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 838567) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NV 838567) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2024-06-27 |