| NPI | 1073003646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 66501) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 33824) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2025-07-02 |