| NPI | 1063676518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 06662R) |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: LA 06662R) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2014-10-01 |