| NPI | 1528115573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 21348) |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: SD 1439) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-11 |