| NPI | 1740819010 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: UT 14206717-1205) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: ID M-17294) | 
| Enumeration Date | 2020-04-07 | 
| Last Update Date | 2025-03-07 |