| NPI | 1619357365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: OR 203312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263517) |
| 207R00000X Internal Medicine (Licence: NY 294546) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2021-08-11 |