| NPI | 1902011778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101232569) |
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: VA 0101232569) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-03-24 |