| NPI | 1720508658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV APRN002585) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV APRN002585) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NV RN79083) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-03-14 |