| NPI | 1124071865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MN 64921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-128967) |
| 207R00000X Internal Medicine (Licence: WI 48270-20) | |
| 208000000X Pediatrics (Licence: IL 036-128967) | |
| 208000000X Pediatrics (Licence: WI 48270-20) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 48270) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-07-08 |