| NPI | 1275003824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV RN65666) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95025381) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2024-06-06 |