| NPI | 1376735035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: ND 11160) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 51542) |
| 208000000X Pediatrics (Licence: ND 11160) | |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: MN 51542) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2022-03-25 |