| NPI | 1447589700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WA MD.60674487) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2016-08-03 |