| NPI | 1841753308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD.MD.61268628) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 14215839-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2026-07-20 |