| NPI | 1114344041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 71788) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A139575) |
| 208000000X Pediatrics (Licence: OH 35.138327) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-06-30 |