| NPI | 1871858043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: GA 89691) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301102029) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301102029) | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2022-05-13 |