| NPI | 1972584753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OR MD25903) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD25903) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD00045144) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2024-09-10 |