| NPI | 1205448941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 833932) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NV RN78172) |
| Enumeration Date | 2020-08-22 |
| Last Update Date | 2023-02-13 |