NPI | 1962854737 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WV 31201) |
Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IL 036149860) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.028502) | |
Enumeration Date | 2016-07-05 |
Last Update Date | 2022-06-28 |