| NPI | 1871832287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95003095) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV APN001488) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NV A0213013) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2022-10-14 |