| NPI | 1568543932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: SD 7905) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: SD 7905) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-07-31 |