| NPI | 1356697916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SD 9713) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT202071) |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MN 58967) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2018-12-10 |