| NPI | 1790944056 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TX P5014) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 243251) | 
| Enumeration Date | 2008-06-03 | 
| Last Update Date | 2013-02-05 |