| NPI | 1760691083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: GA 065999) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2008018932) |
| 208000000X Pediatrics (Licence: AL 27983AL) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-07-29 |