| NPI | 1811317209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MA 274015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 274015) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2021-02-22 |