| NPI | 1669714655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO DR.0056713) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0056713) |
| 208000000X Pediatrics (Licence: MT 70821) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 0056713) | |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2022-07-05 |