| NPI | 1710027602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APN00436) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV RN18055) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2010-11-01 |