| NPI | 1033409016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: UT 9757995-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 9757995-1205) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2021-12-17 |