| 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 |