| NPI | 1972066587 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: WA OP61689646) | 
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: UT 12751743-1204) | 
| Enumeration Date | 2019-04-10 | 
| Last Update Date | 2025-08-19 |