| NPI | 1255726154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MI 4301506542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA a161074) |
| 208000000X Pediatrics (Licence: CA a161074) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-08-11 |