| NPI | 1801130455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV APN001432) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NV APRN001432) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2023-05-30 |