| NPI | 1366721227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 849541) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001187930) |
| 163W00000X Registered Nurse (Licence: NV 849541) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169608) | |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2024-03-19 |