| 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 |