| NPI | 1518209436 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD459077)  | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MT210301)  | 
| Enumeration Date | 2013-03-18 | 
| Last Update Date | 2016-11-15 |