| NPI | 1760837520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TN 70525) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 75390-20) |
| 208000000X Pediatrics (Licence: WI 75390-20) | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2024-05-22 |