| NPI | 1619322484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: VA 0101267505) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: VA 0101267505) | |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2026-09-29 |