| NPI | 1891715090 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA G76297) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G76297A) | 
| Enumeration Date | 2006-07-20 | 
| Last Update Date | 2013-01-23 |