| NPI | 1710681986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: WI 82209-21) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: IL 125.082044) | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2026-07-01 |