| NPI | 1548791122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics Pediatric Cardiology (Licence: MA 1013038) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA 61056540) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-06-11 |