| NPI | 1063771228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 1942-320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 59914) |
| 208000000X Pediatrics (Licence: MN 59917) | |
| 208M00000X Hospitalist (Licence: MN 59914) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2023-08-02 |