| NPI | 1679852891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 19818) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 19818) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2024-10-13 |