| NPI | 1326169061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 49746) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: ND 12259) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208000000X Pediatrics (Licence: MN 49746) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2021-11-18 |