| NPI | 1124171533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: AZ 58983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2768) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: WV 24117) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-08-26 |