| NPI | 1497148126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV APRN002598) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001562) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2020-10-19 |