| NPI | 1174835631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: LA 304683) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A126180) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX BP20048090) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2022-07-21 |