| NPI | 1427648070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 836273) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN86006) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2023-11-07 |