| NPI | 1336854504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 863840) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 10050797) |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2025-11-23 |