| NPI | 1609978717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APN00339) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN28624) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2018-10-02 |