| NPI | 1699332015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV APRN819895) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 819895) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2019-07-30 |