| NPI | 1063074086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME156408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2019022585) |
| Enumeration Date | 2019-06-29 |
| Last Update Date | 2022-07-07 |