| NPI | 1912066283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 370025) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: NY 493388) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2021-04-09 |