| NPI | 1790009595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: MN 57063) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: TX Q8784) |
| 208000000X Pediatrics (Licence: MN 57063) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 57063) | |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2016-06-19 |