| NPI | 1356384754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA 20872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R7186) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: IA 20872) | |
| 207Q00000X Family Medicine (Licence: IA 20872) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-09-19 |