| NPI | 1396031126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME133328) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT199067) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-07-21 |