| NPI | 1417959834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: NY 218128-1) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: NY 218128-1) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-07-08 |