| NPI | 1568661767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: GA 069666) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57012642) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2021-01-25 |