| NPI | 1316154974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: TX S5305) |
| Additional Taxonomies | 2080P0202X Pediatrics Pediatric Cardiology (Licence: MS 21133) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2021-01-14 |