| NPI | 1487107355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 835371) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN670925) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2021-04-06 |