NPI | 1104010651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QX0200X Clinic/Center, Oncology (Licence: PR 17625) |
Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: PR 17625) |
282N00000X General Acute Care Hospital (Licence: PR 17625) | |
Enumeration Date | 2007-08-28 |
Last Update Date | 2020-01-28 |