| NPI | 1417187683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA 60585583) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301093877) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2018-05-21 |