| NPI | 1043652662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: GA 049383) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 206372) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |