| NPI | 1639141104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME102470) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD426300) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2011-11-29 |