| NPI | 1447642517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APRN001894) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 001894) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2023-01-13 |