| NPI | 1891082764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME141896) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA A149517) |
| 2080P0202X Pediatrics, Pediatric Cardiology (Licence: PA MD468026) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: PA MD468026) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2022-03-11 |