| NPI | 1306987474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6499) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX N6499) |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TX N6499) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2023-03-07 |