| NPI | 1013393735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 321049) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NY 321049) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NY 321049) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2023-05-16 |