| NPI | 1306265723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV APRN001757) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN14274) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2018-10-30 |