| NPI | 1619448289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 816226) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV 816226) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NV 816226) | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2020-08-05 |