| NPI | 1811250772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301109244) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 65441) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2020-11-11 |