| NPI | 1780097170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics Pediatric Hematology-Oncology (Licence: CA A170292) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ R74520) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-01-20 |