| NPI | 1790126035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: UT 14210205-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58.005155) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2025-07-02 |