| NPI | 1164649687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 47199) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.015260) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO DR.0047199) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2026-01-07 |