| NPI | 1780033852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: NE 30220) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 30220) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-06-02 |