| NPI | 1780028811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001552) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN53059) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2016-04-19 |