| NPI | 1962934885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV APRN002559) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV aprn002559) |
| 163W00000X Registered Nurse (Licence: NV 74214) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 002559) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-12-22 |