| NPI | 1730865239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME179243) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301517676) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-07-06 |