| NPI | 1760773964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MN 81755) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD193630) |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: OR MD193630) | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2026-04-21 |