| NPI | 1669455754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CO 35397) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: AZ 31487) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: WY 6089A) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2012-02-10 |