| NPI | 1346555943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11532) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2015-06-24 |