| NPI | 1851685168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: FL OS14799) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT014162) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2022-07-21 |