| NPI | 1326631276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: GA 259704) |
| Additional Taxonomies | 163WP0200X Registered Nurse Pediatrics (Licence: GA 259704) |
| 163WP0218X Registered Nurse Pediatric Oncology (Licence: GA 259704) | |
| 163WX0200X Registered Nurse Oncology (Licence: GA 259704) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: GA 259704) | |
| 163W00000X Registered Nurse (Licence: GA 259704) | |
| 163WI0500X Registered Nurse Infusion Therapy (Licence: GA 259704) | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2024-02-05 |