| NPI | 1275822611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001258) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV APN001258) |
| 163W00000X Registered Nurse (Licence: NV RN67477) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2020-09-02 |