| NPI | 1982679817 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 26111) | 
| Additional Taxonomies | 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MN 26111) | 
| Enumeration Date | 2006-02-22 | 
| Last Update Date | 2025-09-11 |