| NPI | 1104351998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CO DR.0063901) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 70149) |
| Enumeration Date | 2017-04-29 |
| Last Update Date | 2023-07-25 |