| NPI | 1700879350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 39656) |
| Additional Taxonomies | 207RH0000X Internal Medicine Hematology (Licence: MA 39656) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-07-08 |