| NPI | 1649217134 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301071731) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301071731) | 
| Enumeration Date | 2006-06-01 | 
| Last Update Date | 2022-12-19 |