| NPI | 1114132818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: LA MD.202844) |
| Additional Taxonomies | 2085R0001X (Licence: KY 41160) |
| 2085R0001X (Licence: LA MD.202844) | |
| 2085R0001X (Licence: ND 13495) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-04-28 |