| NPI | 1083241863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2020017189) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IL 036.169-21) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-04-01 |