| NPI | 1962882969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 80085) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD464480) |
| 208000000X Pediatrics (Licence: PA MT208303) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2025-09-09 |