| NPI | 1790748556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: OR MD08402) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD08402) |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: OR MD08402) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2017-04-28 |