| NPI | 1912966011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 29255) |
| Additional Taxonomies | 207RH0000X Internal Medicine, Hematology (Licence: MA 29255) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2007-07-08 |