NPI | 1780047647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MI 4301117285) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-03-29 |
Last Update Date | 2024-02-14 |