| NPI | 1316511157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TX V6260) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM NM2024-0922) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-09-03 |