| NPI | 1154331148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NC 2013-01224) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL29148) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-03-30 |