| NPI | 1700430188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 859953) |
| Additional Taxonomies | 101Y00000X Counselor |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 859953) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2025-04-28 |