| NPI | 1609397611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: GA 86140) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116030834) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2023-06-13 |