| NPI | 1104081132 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 34.010243)  | 
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: OH 34.010243)  | 
| Enumeration Date | 2008-07-18 | 
| Last Update Date | 2025-01-10 |