NPI | 1972852119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: KS 0438971) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 14876) |
Enumeration Date | 2012-09-04 |
Last Update Date | 2016-08-04 |