| NPI | 1730171745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME128404) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 35059340) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301069375) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-01-01 |