| NPI | 1528448388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX U4560) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-08652) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-07-12 |