| NPI | 1487114583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 820069) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN78322) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2019-06-20 |