| NPI | 1528203643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APN#001061) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN44618) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2022-09-28 |