| NPI | 1104183631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA A128805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A128805) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A128805) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2018-08-09 |