| NPI | 1881935237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 001503) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 700891) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2021-04-12 |