| NPI | 1902463003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 820636) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 820636) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-03-14 |