| NPI | 1184827107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RX0202X Internal Medicine Medical Oncology (Licence: MA 279255) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101240150) |
| 207RH0000X Internal Medicine Hematology (Licence: MA 279255) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2019-07-02 |