NPI | 1699657957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: KY TP680) |
Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 35.077143) |
Enumeration Date | 2025-07-25 |
Last Update Date | 2025-10-06 |