| NPI | 1619960416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RX0202X Internal Medicine, Medical Oncology (Licence: KY 21239) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: KY 21239) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: OH 35040832) | |
| 207RX0202X Internal Medicine, Medical Oncology (Licence: OH 35.040832) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2020-10-01 |