| NPI | 1215102173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME129317) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME129317) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD425871) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MO 2009020439) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2017-07-10 |