| NPI | 1104043710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IA 41078) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 51840) |
| 208000000X Pediatrics (Licence: IA 41078) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2013-08-05 |