| NPI | 1508804089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VT 042-0011477) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NJ 25MA06848600) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2007-12-13 |