| NPI | 1275923278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 842879) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: NV 842879) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2024-03-24 |