| NPI | 1891987111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 199988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 25216) |
| 207RH0003X Internal Medicine, Hematology & Oncology (Licence: LA 19988) | |
| 208000000X Pediatrics (Licence: LA 199988) | |
| 208000000X Pediatrics (Licence: NE 25216) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2022-04-07 |