| NPI | 1912403882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A174104) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: NM MD2024-0068) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-03-20 |