| NPI | 1245648013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001962) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95000786) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95000786) | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2022-10-26 |