| NPI | 1508179607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA A172284) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: WV 26214) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 26214) | |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2021-08-19 |