| NPI | 1114139656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: LA MD.204668) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX M4746) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-10-04 |