| NPI | 1699875716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD 00049264) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 48231) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2022-10-25 |