| NPI | 1508112731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: FL ME122512) |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: NY 004115) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2024-07-01 |