| NPI | 1790773513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX E1645) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E1645) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2012-05-01 |