| NPI | 1487330445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA OT025609) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 15170) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2026-08-03 |