| NPI | 1629277348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: UT 9383826-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME T0707) |
| 208000000X Pediatrics (Licence: ME T0707) | |
| 208000000X Pediatrics (Licence: WI 55580) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2021-11-12 |