| NPI | 1780883405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: ME DO2953) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME T0712) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: UT 7676017-1204) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2019-10-16 |