| NPI | 1861817934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NV APRN001431) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NV 001431) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NV APRN001431) | |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2024-03-01 |