| NPI | 1336719764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 846594) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN73820) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2021-11-01 |