| NPI | 1396919536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX P3365) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2005016378) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2021-11-17 |