| NPI | 1952376519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 36075) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 36075) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA 36075) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2011-02-25 |