| NPI | 1093058844 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A132168)  | 
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TN 55698)  | 
| Enumeration Date | 2013-03-30 | 
| Last Update Date | 2024-02-29 |