| NPI | 1467751560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: NY 260552-01) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 260552-1) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2022-09-07 |