| NPI | 1982821799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME113107) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME113107) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CO DR47006) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2025-05-16 |