| NPI | 1306063128 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: NC 2007-00310) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2007-00310) | 
| 208000000X Pediatrics (Licence: NC 2007-00310) | |
| Enumeration Date | 2007-04-20 | 
| Last Update Date | 2024-07-15 |