| NPI | 1710922067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: WA MD60067855) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 40375) |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MN 40375) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2009-04-29 |