NPI | 1003962614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MA FF2575186) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CO 45818) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1360) | |
Enumeration Date | 2007-01-26 |
Last Update Date | 2020-11-18 |