| 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 |