| NPI | 1619446515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 832892) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 832892) |
| 106S00000X Behavior Technician | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2024-03-21 |