| NPI | 1255565289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: NE 26196) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 18181) |
| 208000000X Pediatrics (Licence: NE 26196) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2021-08-11 |