| NPI | 1245763721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TN 67446) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.142265) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: TN 67446) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2023-07-07 |