| NPI | 1467223008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 875418) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN73425) |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-04-06 |