| NPI | 1962757336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD455555) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VA 0101263354) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2021-10-11 |