| NPI | 1215963996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 837765) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 091006311) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2021-05-26 |