| NPI | 1104851351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: CO 18299) |
| Additional Taxonomies | 261QX0200X Clinic/Center, Oncology |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2017-11-06 |