| NPI | 1770905838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9484222) |
| Additional Taxonomies | 364SX0200X Clinical Nurse Specialist, Oncology (Licence: FL APRN9484222) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2021-03-31 |