| NPI | 1215449830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 274639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 146289) |
| Enumeration Date | 2017-11-05 |
| Last Update Date | 2022-03-01 |