| NPI | 1316232168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: WA MD60949870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 275871) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: RI LP03639) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2019-06-21 |