| NPI | 1972759157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME165205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT193347) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD443172) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2023-11-21 |