| NPI | 1205255627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: UT 12308406-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 63768) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-07-13 |