| NPI | 1760896336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 872562) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000176) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2025-04-23 |