| NPI | 1548417058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX G6016) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G6016) |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: CA A38896) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2015-05-04 |