| NPI | 1831771542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MN 80093) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116035128) |
| 208000000X Pediatrics (Licence: VA 0116035128) | |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2025-06-20 |