| NPI | 1003101551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: VA 0101252304) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101252304) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-09-05 |