| NPI | 1811933005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: FL ME125328) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IA 40200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-11-10 |