| NPI | 1699360065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 12345127-4405) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: UT 10670291-3102) |
| Enumeration Date | 2021-03-07 |
| Last Update Date | 2021-07-29 |