| NPI | 1518386853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: NY 314660) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 314660) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 78952) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-07-17 |