| NPI | 1215553326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 831828) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 831828) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2021-08-26 |