| NPI | 1790970986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 278113) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: DC MD042447) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2019-04-05 |