| NPI | 1831767441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 202110719NP-PP) |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: OR 201808002RN) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: OR 202110719NP-PP) | |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-10-14 |