| NPI | 1447441027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD60458778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60458778) |
| 208000000X Pediatrics (Licence: WA MD60458778) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2015-07-15 |