| NPI | 1760019616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CO DR.0077357) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WY 15776A) |
| 208000000X Pediatrics (Licence: CO DR.0077357) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-08-13 |