| NPI | 1063473890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RX0202X Internal Medicine, Medical Oncology (Licence: FL ME99189) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA MD024878E) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2013-04-09 |