| NPI | 1548471204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WI 66296) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 37765) |
| 208000000X Pediatrics (Licence: IN 01072604A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-05-14 |