| NPI | 1174789523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: WA MD60215606) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT192880) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2014-06-11 |