| NPI | 1780817460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NY 296718) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VA 0101258037) |
| 208000000X Pediatrics (Licence: MI 4301094670) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 098759) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TN 52737) | |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2019-02-04 |