| NPI | 1407349715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 812685) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: HI RN80851) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-2456) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-03-19 |