| NPI | 1740262484 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MA 217458)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 213888)  | 
| Enumeration Date | 2005-11-17 | 
| Last Update Date | 2008-01-01 |