NPI | 1578975363 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NY 309047) |
Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD045139) |
208000000X Pediatrics (Licence: NY 309047) | |
363AM0700X Physician Assistant, Medical (Licence: NY 309047) | |
Enumeration Date | 2014-05-28 |
Last Update Date | 2023-07-07 |