| NPI | 1023229051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: UT 7365826-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 24157) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-01-06 |