| NPI | 1326551219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 821380) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95007843) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2020-01-22 |