| NPI | 1073507653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CT 063899) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NY 1918661) |
| 208D00000X General Practice (Licence: NY 1918661) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2019-07-17 |