| NPI | 1730509191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CO DR.0058857) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0058857) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2022-04-25 |