| NPI | 1811275944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD61142250) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125059327) |
| 208000000X Pediatrics (Licence: IL 125059327) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2021-09-12 |