| NPI | 1679846737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APRN001362) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN45455) |
| 164W00000X Licensed Practical Nurse (Licence: NV APN001362) | |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2016-01-14 |