| NPI | 1518501295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 857088) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 163W00000X Registered Nurse (Licence: NV 857088) | |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2025-10-23 |