| NPI | 1003173592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MA 285014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-125390) |
| 207R00000X Internal Medicine (Licence: TN 54683) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2021-03-01 |