| NPI | 1841751179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA OP61652713) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 6999) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-05-21 |