| NPI | 1679101562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME180106) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 30881) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2026-08-20 |