| NPI | 1669565149 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0013378)  | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NJ 25MA10794000)  | 
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 35081983L)  | |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX Q2330)  | |
| Enumeration Date | 2006-10-02 | 
| Last Update Date | 2020-12-24 |