| NPI | 1912210899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD60739164) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD457491) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD457491) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2022-11-03 |