| NPI | 1912902602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA A70509) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: GU M-1618) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2026-03-31 |