NPI | 1326433236 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MA 273917) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-03-30 |
Last Update Date | 2021-01-12 |