| NPI | 1619001872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: MI 4301082158) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301082158) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301082158) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2022-03-26 |