| NPI | 1619362688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: FL ME168366) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TN 64057) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2024-08-07 |