| NPI | 1215224712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX T4999) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101250045) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TN 54765) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2022-07-27 |