| NPI | 1073625059 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MT 79448)  | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VT 042-0008944)  | 
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NH 9173)  | |
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2025-04-09 |