| NPI | 1851611362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2009003439) |
| Additional Taxonomies | 2080P0202X Pediatrics Pediatric Cardiology (Licence: PA OT013523) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2013-06-03 |