| NPI | 1699728022 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD00042494)  | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: ID M-9469)  | 
| Enumeration Date | 2006-05-18 | 
| Last Update Date | 2021-06-02 |