| NPI | 1679714299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: OR 201050004NP) |
| Additional Taxonomies | 163WX0200X Registered Nurse Oncology (Licence: OR 097006731RN) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2021-03-15 |