| NPI | 1356353791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704225508) |
| Additional Taxonomies | 364SX0200X Clinical Nurse Specialist, Oncology (Licence: MI 4704225508) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2024-08-30 |