| NPI | 1164500070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: HI MD-18218) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA C50191) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-07-31 |