| NPI | 1790990562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: LA 302176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 43070) |
| 208000000X Pediatrics (Licence: TN 43070) | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TN 43070) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2016-08-03 |