| NPI | 1245626647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine Hematology & Oncology (Licence: CA A178359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.133850) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2025-05-21 |