NPI | 1518497247 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: LA 347810) |
Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101270353) |
208000000X Pediatrics (Licence: CT 67606) | |
208000000X Pediatrics (Licence: VA 0116030336) | |
Enumeration Date | 2017-06-14 |
Last Update Date | 2025-08-04 |