| NPI | 1720136369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME114324) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL TRN9188) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TN 44085) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-08-08 |