| NPI | 1225270804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME136219) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-128178) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35-128178) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 60 268245) | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2023-01-24 |