| NPI | 1104213412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CO DR.0059282) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0059282) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2024-02-20 |