| NPI | 1891291704 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 81958-21) | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IL 036.168419) | 
| Enumeration Date | 2018-04-01 | 
| Last Update Date | 2025-09-04 |