| NPI | 1710351184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APRN002075) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002075) |
| Enumeration Date | 2015-11-22 |
| Last Update Date | 2023-12-20 |