| NPI | 1831876374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 822777) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022731) |
| 363LF0000X Nurse Practitioner, Family (Licence: NV TEMP822777) | |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-08-08 |