| NPI | 1235608589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 813541) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV 813541) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 813541) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 813541) | |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2026-03-20 |