| NPI | 1790020618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine Hematology & Oncology (Licence: NY 288996) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO 2945) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2024-10-09 |