| NPI | 1518212612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME142063) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NY 271013) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2019-10-10 |