| NPI | 1720384993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NV APRN001629) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV APRN001629) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 20309) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001629) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2022-08-16 |