| NPI | 1902291693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CO DR.0068014) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 60514) |
| 208000000X Pediatrics (Licence: CO DR.0068014) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 1.061265-RES) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-04-21 |