| NPI | 1225215999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD60107076) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: GA 060603) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2009-09-21 |