| NPI | 1922116664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine Hematology & Oncology (Licence: CA A70830) |
| Additional Taxonomies | 207RH0003X Internal Medicine Hematology & Oncology (Licence: NV 18467) |
| 207RH0003X Internal Medicine Hematology & Oncology (Licence: AZ 45450) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 6498490001) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2019-08-19 |