| NPI | 1275038556 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 65953) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 29597) | 
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IL 036.155793) | |
| Enumeration Date | 2018-03-28 | 
| Last Update Date | 2025-08-22 |