| NPI | 1548244155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 12204) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PR 12204) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PR 12204) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2013-03-21 |