| NPI | 1710059381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CO DR.0050872) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MO 2007024789) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-08-09 |