| NPI | 1124245618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MO 2012014545) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 5155) |
| 208000000X Pediatrics (Licence: NE 5155) | |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: KY 42699) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-10-30 |