| NPI | 1700882529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: RI MD06656) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: RI MD06656) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: WI 40994-020) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 204275) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 204275) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2020-12-07 |