| NPI | 1659869881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV R0069144) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0069144) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 69144) | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2024-02-07 |