| NPI | 1154825479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 165375) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0067934) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2022-07-11 |