| NPI | 1972814184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A167757) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 268547) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IA R-09949) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-04-16 |