| NPI | 1124375134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: KY 48037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 48037) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2018-04-06 |