| NPI | 1720063001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NY 160021) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 160021) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2013-03-26 |