| NPI | 1649521170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 885460) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2025-06-04 |