| NPI | 1487210720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN197656) |
| Additional Taxonomies | 207RX0202X Internal Medicine, Medical Oncology (Licence: GA RN197656) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-06-11 |