NPI | 1053774802 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO DR.0068651) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CA A162467) |
Enumeration Date | 2016-03-30 |
Last Update Date | 2022-08-12 |