| NPI | 1619710522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 850216) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 850216) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-02-09 |