| NPI | 1477973121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19631) |
| Additional Taxonomies | 2080P0202X Pediatrics Pediatric Cardiology (Licence: MO 2023027370) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2023-09-06 |