| NPI | 1972508703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD27239) |
| Additional Taxonomies | 2080P0202X Pediatrics Pediatric Cardiology (Licence: TN 27239) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2023-03-07 |