| NPI | 1780769323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001750) |
| Additional Taxonomies | 364SX0200X Clinical Nurse Specialist, Oncology (Licence: IA 0001750IA) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-10-01 |