| NPI | 1134315203 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX N6700) | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA A97663) | 
| Enumeration Date | 2007-09-21 | 
| Last Update Date | 2024-05-22 |