| NPI | 1609851187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA c51341) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA c51341) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2014-12-29 |