| NPI | 1326631276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP259704) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN259704) |
| 163WP0200X Registered Nurse, Pediatrics (Licence: GA RN259704) | |
| 163WX0200X Registered Nurse, Oncology (Licence: GA RN259704) | |
| 163WP0218X Registered Nurse, Pediatric Oncology (Licence: GA RN259704) | |
| 163WI0500X Registered Nurse, Infusion Therapy (Licence: GA RN259704) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA APRN-NP259704) | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2025-11-21 |