| NPI | 1760640114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL 126759) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX BP10023678) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: AZ 40883) | |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2021-11-01 |