| NPI | 1336587641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002491) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 17652) |
| Enumeration Date | 2013-06-08 |
| Last Update Date | 2021-08-26 |