| NPI | 1629350970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: WV 27451) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 27451) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2022-04-06 |