| NPI | 1013265776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0023876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA10956600) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 251206) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2021-07-14 |