| NPI | 1003115445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: MO 2018001490) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301104465) |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: KS 04-40728) | |
| 2080P0202X Pediatrics Pediatric Cardiology (Licence: MI 4301104465) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2018-04-30 |