| NPI | 1205148061 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: UT 9721871-1204) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2010019803) | 
| Enumeration Date | 2010-07-09 | 
| Last Update Date | 2016-07-20 |