| NPI | 1902146657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001535) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 22779) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2018-12-19 |