| NPI | 1700063914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MD D76535) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 390200000X) |
| 208000000X Pediatrics (Licence: MD D76535) | |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2013-08-19 |