| NPI | 1164712568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CO DR.0053858) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO DR.0053858) | |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2016-02-05 |