| NPI | 1770846149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: GA 82395) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN16214) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: MA 269973) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-01-22 |