| NPI | 1861780108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: SD 11928) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198871) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: SC 40753) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2020-06-29 |