| NPI | 1639341167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APN001037) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN41949) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2009-10-01 |