| NPI | 1053553966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME140887) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX R2913) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 56470-20) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: WI 56470) | |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2021-10-20 |