| NPI | 1447612155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: FL ME169264) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 019287) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2025-09-02 |