| NPI | 1659869063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: NC 2021-01355) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2021-01355) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 238167) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-09-08 |