| NPI | 1285913103 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: CA C201623) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C201623) | 
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MD D0091691) | |
| Enumeration Date | 2011-08-09 | 
| Last Update Date | 2025-07-07 |