| NPI | 1558646349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TX R3146) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH resident in training) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2022-01-27 |