| 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 |