| NPI | 1285013623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301517072) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NY 310255) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 310255) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2026-05-26 |