| NPI | 1770504995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 37766) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: ND 6952) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-11-10 |