| NPI | 1043741523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: CA A161136) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 161136) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2026-03-16 |