| NPI | 1215149083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: VA 0101242407) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101242407) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016406) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2019-08-27 |