| NPI | 1164442836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 813635) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP2914192) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 2914192) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-05-23 |