| NPI | 1770089815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OK 46058) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TN 71176) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2025-12-24 |