| NPI | 1578115077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD49418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11702) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: KY 56967) | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2022-08-15 |