| NPI | 1659129807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 826544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 826544) |
| 163WH0200X Registered Nurse, Home Health (Licence: NV 826544) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 826544) | |
| Enumeration Date | 2024-05-10 |
| Last Update Date | 2025-10-27 |