| NPI | 1881817179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD48290) |
| Additional Taxonomies | 207RH0003X Internal Medicine Hematology & Oncology (Licence: WA MD48290) |
| 207R00000X Internal Medicine (Licence: CA A83207) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |