| NPI | 1154507952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA A119874) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301084071) |
| 207R00000X Internal Medicine (Licence: MI 4301084071) | |
| 208000000X Pediatrics (Licence: MI 4301084071) | |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2020-03-09 |