| NPI | 1588930671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: TX Q4207) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.205446) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2015-09-22 |