| NPI | 1194130054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: UT 12117975-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 9408510) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2021-11-04 |