| NPI | 1255305074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 45128) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 45128) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2012-12-10 |