| NPI | 1164612560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 854418) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 30642) |
| 207X00000X Orthopaedic Surgery (Licence: NM cnp-02552) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 804371) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM cnp-02552) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2023-08-28 |