| NPI | 1922543131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RX0202X Internal Medicine, Medical Oncology (Licence: NC 5009668) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 250967) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5009668) | |
| Enumeration Date | 2016-12-23 |
| Last Update Date | 2019-09-17 |