| NPI | 1376926436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: OH 35.135580) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3818) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2019-07-03 |