| NPI | 1245375567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R1D36) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036069763) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: IL 036069763) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-05-13 |