| NPI | 1487918751 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 35.125565) | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: KY 52975) | 
| Enumeration Date | 2012-07-01 | 
| Last Update Date | 2019-12-04 |