| NPI | 1588923205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MA 283655) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD043316) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 5561) | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2020-11-17 |