| NPI | 1851377071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0074560) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 009000331) |
| 208000000X Pediatrics (Licence: FL ME123206) | |
| 208000000X Pediatrics (Licence: CO DR.0074560) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-07-09 |