| NPI | 1245842699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: KY 56582) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 85807) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2022-07-28 |