| NPI | 1578705612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: VA 0101260331) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: MA 261866) | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2017-04-26 |