| NPI | 1114592565 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program | 
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OR MD225029) | 
| Enumeration Date | 2021-05-26 | 
| Last Update Date | 2025-07-10 |