| NPI | 1558563551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: MA 254559) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP01101) |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: MI 4301096262) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-11-15 |