| NPI | 1093970840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: WA MD60236708) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA 390200000X) |
| 208000000X Pediatrics (Licence: WA ML60019945) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2018-11-06 |