| NPI | 1912234121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: CA C175032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD14130) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MA 253762) | |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2024-02-05 |