| NPI | 1982863882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APN001048) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN001048) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2020-11-05 |