| NPI | 1871755447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TN 57263) |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: TX P9066) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH AU2866626X053) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2019-04-01 |