Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 2018-00466 | NC |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 2018-00466 | NC |
NPI | 1174935431 |
---|---|
Provider Name | Samuel Wilson |
First Address | Chapel Hill, NC 27599-7236 |
Second Address | Chapel Hill, NC 27599-5368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 06/05/2018 |