| NPI | 1720604374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: KY 58137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020016812) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2026-05-19 |