| NPI | 1619616687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 854083) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 854083) |
| Enumeration Date | 2022-05-29 |
| Last Update Date | 2023-01-17 |