| NPI | 1114330339 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MI 4301105382)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301105382)  | 
| Enumeration Date | 2014-06-05 | 
| Last Update Date | 2020-09-04 |