| NPI | 1972167534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NM DO2025-0039) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL82127) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2025-07-29 |