| NPI | 1770903726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: FL ME131694) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA T290338) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL G514068872450) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2023-02-01 |