| NPI | 1750525192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VT 042-0013411) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 050556) |
| 208000000X Pediatrics (Licence: NY 278442) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2024-03-15 |