| NPI | 1003256553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TX S1855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.022414) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2019-06-10 |