| NPI | 1730851692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 845704) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV RN70109) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2024-10-30 |