| NPI | 1063622090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101245157) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018547) |
| 208000000X Pediatrics (Licence: FL ME 112786) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME112786) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-08-01 |