| NPI | 1629372800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN001965) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN67966) |
| 163W00000X Registered Nurse (Licence: CA 850224) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001965) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95001903) | |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2022-06-21 |