| NPI | 1104171388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 292105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2012019666) |
| 207RH0000X Internal Medicine Hematology (Licence: NY 292105) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2023-06-30 |