| NPI | 1689089682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VA 0101262552) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0116027482) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2025-11-03 |