| NPI | 1164569448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0214X Pediatrics Pediatric Pulmonology (Licence: CO 46572) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-141) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2022-02-22 |