NPI | 1669455911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: SC 40830) |
Additional Taxonomies | 208000000X Pediatrics (Licence: AK A79126) |
2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA A79126) | |
2080P0202X Pediatrics, Pediatric Cardiology (Licence: NM MD2012-0048) | |
2080P0202X Pediatrics, Pediatric Cardiology (Licence: ID M-11565) | |
Enumeration Date | 2005-11-21 |
Last Update Date | 2021-10-01 |