| NPI | 1972792075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN000962) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NV APRN000962) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NV APRN000962) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2017-02-09 |