| NPI | 1487699450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: VA 0101057513) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101057513) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-02-03 |