| NPI | 1770962888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: VA 0101261696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101261696) |
| 208D00000X General Practice (Licence: VA 0101261696) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-06-28 |