| 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 |