| NPI | 1023689510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: MA RN2336913) |
| Additional Taxonomies | 163WX0200X Registered Nurse Oncology (Licence: MA RN2336913) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2021-09-13 |