| NPI | 1154525244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CT 52090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT186318) |
| 208000000X Pediatrics (Licence: PA MT186318) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2013-06-10 |