| NPI | 1578005658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002386) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN76812) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: NV APRN002386) | |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2020-11-03 |