| NPI | 1093004277 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: ND 9801)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 9801)  | 
| Enumeration Date | 2011-03-29 | 
| Last Update Date | 2011-03-29 |