| NPI | 1801183090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: OH 35.130455) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 61503) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2017-07-16 |