| NPI | 1457395980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 48174) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA MA48174) |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MA 48174) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2015-09-08 |