| NPI | 1306076252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD.MD.70066830) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 60073) |
| 208000000X Pediatrics (Licence: MD P23945) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2026-08-05 |