| NPI | 1659787075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD.60742111) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2022-07-21 |