| NPI | 1841485612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME100438) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50847-020) |
| 208000000X Pediatrics (Licence: WI 50847-020) | |
| 207R00000X Internal Medicine (Licence: FL ME100438) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2013-10-04 |