| NPI | 1801230123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: TX Q7779) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: TX Q7779) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2020-07-08 |