| NPI | 1952183774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN249427) |
| Additional Taxonomies | 207RH0003X Internal Medicine Hematology & Oncology (Licence: GA RN249427) |
| Enumeration Date | 2023-10-17 |
| Last Update Date | 2024-02-21 |