| NPI | 1629245915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: TX S4974) |
| Additional Taxonomies | 2080P0202X Pediatrics Pediatric Cardiology (Licence: MN 52674) |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: FL TRN7231) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2021-04-19 |