| NPI | 1164609970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME119556) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 002049) |
| 208000000X Pediatrics (Licence: NC 2012-00170) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2014-05-29 |