| NPI | 1891144374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN002196) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN62564) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-15 |