| NPI | 1124013826 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: AL 29486)  | 
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: IA 28926)  | 
| 208000000X Pediatrics (Licence: AL 29486)  | |
| Enumeration Date | 2005-09-19 | 
| Last Update Date | 2011-01-26 |