| NPI | 1003298126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 283956) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX Q8849) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA ETL5309) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2021-03-11 |