| NPI | 1154563260 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NC 2016-00446)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 254746)  | 
| Enumeration Date | 2009-04-03 | 
| Last Update Date | 2017-09-14 |