| NPI | 1588047989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 835170) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-05-22 |