| NPI | 1619962032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: LA 15187R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 15187R) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2021-08-31 |